| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,736 |
1,230 |
$509K |
| D0145 |
Oral evaluation for a patient under three years of age |
3,016 |
2,953 |
$415K |
| D1351 |
Sealant - per tooth |
14,926 |
3,919 |
$400K |
| D1120 |
Prophylaxis - child |
9,521 |
9,334 |
$326K |
| D0120 |
Periodic oral evaluation - established patient |
8,140 |
7,978 |
$226K |
| D1208 |
Topical application of fluoride, excluding varnish |
11,088 |
10,880 |
$155K |
| D0272 |
Bitewings - two radiographic images |
6,643 |
6,490 |
$147K |
| D9248 |
|
1,212 |
1,146 |
$138K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,785 |
1,091 |
$130K |
| D1110 |
Prophylaxis - adult |
1,711 |
1,681 |
$89K |
| D0330 |
Panoramic radiographic image |
1,361 |
1,343 |
$84K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,123 |
4,338 |
$72K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,244 |
598 |
$70K |
| D0220 |
Intraoral - periapical first radiographic image |
6,047 |
5,811 |
$70K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
651 |
444 |
$62K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,195 |
2,091 |
$56K |
| D0274 |
Bitewings - four radiographic images |
1,662 |
1,635 |
$56K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,326 |
1,279 |
$44K |
| D0350 |
|
1,600 |
1,507 |
$18K |
| D1354 |
|
1,459 |
479 |
$17K |
| D9420 |
|
297 |
283 |
$10K |
| D2934 |
|
46 |
14 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
277 |
262 |
$5K |
| D1330 |
|
316 |
310 |
$4K |
| D1352 |
|
82 |
45 |
$3K |
| D7111 |
|
17 |
12 |
$193.21 |
| D0603 |
|
12,481 |
12,247 |
$0.00 |